Provider Demographics
NPI:1639444110
Name:MARCIANO, JANETTE S (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JANETTE
Middle Name:S
Last Name:MARCIANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:S
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:626 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2444
Mailing Address - Country:US
Mailing Address - Phone:217-345-7702
Mailing Address - Fax:217-345-7705
Practice Address - Street 1:626 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2444
Practice Address - Country:US
Practice Address - Phone:217-345-7702
Practice Address - Fax:217-345-7705
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-004294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant